But there can be side effects. One is short bowel syndrome (SBS), a malabsorption disorder that occurs when some of the intestine and the rest of the bowels cannot compensate after surgical resection. This condition can result in diarrhea, dehydration, and malnutrition. The severity of the symptoms depends on both the length and condition of the remaining bowel. “The small bowel is responsible for the absorption of both macronutrients like carbohydrates, proteins, and fats, as well as micronutrients, or vitamins and minerals,” says Shirley Paski, MD, director of the small bowel diseases and nutrition program at Cedars-Sinai in Los Angeles. Removing sections of the intestine compromises the body’s ability to get proper nutrition, she says. Though SBS is relatively rare — affecting three out of every million people, according to the National Institute of Diabetes and Digestive and Kidney Diseases — without proper treatment, the disorder is potentially fatal. SBS can also put you at risk for a host of complications, notes Dr. Paski, like liver disease, kidney stones, peptic ulcers, and an overgrowth of bacteria. Additionally, SBS increases the risk for food allergies and sensitivities, like lactose intolerance.
What Are the Symptoms of Short Bowel Syndrome?
Symptoms of SBS usually occur immediately following surgery, though sometimes they are delayed. The most common of these is chronic diarrhea. Other symptoms include:
CrampingBloatingHeartburnWeaknessFatigueBacterial infectionsFoul-smelling stoolExcessive gas
If you experience any of these symptoms after bowel resection surgery, consult your doctor. You may need to undergo diagnostic tests to determine if you have SBS.
Treatment for Short Bowel Syndrome
It’s important to treat the symptoms on an individual basis, since the treatment varies according to the severity of the disease and how much of the intestine — and which parts — were removed. The first place to start is with diet, Paski says. “Because there is insufficient length of the GI tract and it can only absorb so much at one time, we try to take advantage of feeding it as much as possible with multiple meals throughout the day,” she explains. Patients should aim for three smaller meals and three snacks each day. “Ideally, you’ll want to work with a GI dietitian with experience with short bowel syndrome to determine the appropriate diet to meet your macro and micronutrient needs,” Paski says. It’s important to reintroduce food slowly, with small, nutritious, and frequent meals throughout the day, while avoiding foods that are high in fat and sugar. Foods like bananas, oatmeal, rice, tapioca, applesauce, and yogurt can help control diarrhea. It’s also best to drink liquids between, rather than with, meals, since drinking with meals can speed up digestion (leading to diarrhea) and may make you feel too full. In addition to dietary changes, you may also need to supplement with vitamins and minerals to meet your daily nutritional needs. Some patients have such severe SBS that they need medically supported nutrition, administered either with an IV (parenteral nutrition) or enterally, through a tube in the stomach. To treat your symptoms, your doctor may also prescribe the following:
H2 blockers or proton pump inhibitors, to treat excessive acid secretionAnti-diarrheal medicines, such as Imodium (loperamide)Oral rehydration solutionsGrowth hormones, like Gattex (teduglutide), to help the bowel take in more fluids and nutrients
Surgery for Short Bowel Syndrome
Some patients with SBS need surgery, which is done to increase the small intestine’s ability to absorb nutrients, prevent blockages, increase the surface area of the intestine, or narrow any area that is too wide. The bowel can adapt to the new situation, but it does take time, notes Abdullah Shatnawei, MD, a gastroenterologist who specializes in SBS at the Cleveland Clinic in Ohio. Treatment time can vary from a few months to a few years. Because SBS can be disabling and has a significant emotional and physical impact on both the individual and their family, “treatment requires a multidisciplinary approach at a highly specialized center,” adds Dr. Shatnawei. Sometimes an intestinal transplant is performed. This procedure is done by transplant surgeons who remove the diseased small intestine and replace it with a healthy one from someone who has just died. It is also possible for a living person to donate a portion of their small intestine. Because of the risks involved, intestinal transplants are reserved for people for whom other treatments have failed or who have developed complications that don’t allow them to continue using total parenteral nutrition, Paski says. Complications associated with intestinal transplant include susceptibility to infections and rejection of the transplanted organ. However, the procedure can be life-saving for those with intestinal failure. Your doctor can discuss whether or not an intestinal transplant is an option for you. Additional reporting by Ashley Welch.
